Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults

Dennis A. Brooks, MD; Richard Clover, MD

J Am Board Fam Med. 2006;19(6):603-611.

Pathogenesis of Infection

Details of the pathogenesis of pertussis infection have been extensively reviewed elsewhere.^[23] In brief, the development of pertussis infection begins with entry of B. pertussis into the respiratory tract of a susceptible host. The organism produces adhesion and bacterial surface attachment factors that allow its attachment to cilia in the respiratory mucosa. Tracheal cytotoxin and other toxins are produced and released into the local environment, damaging the cilia and respiratory epithelium. These changes disturb clearance of pulmonary secretions and probably result in development of the coryza and cough observed during the catarrhal phase of the illness. Even as local damage increases, attracting host immune cells, the actions of additional toxins probably inhibit phagocyte functions, thereby protecting the proliferating organisms from clearance. In some cases, the proliferation of B. pertussis continues until organisms reach the alveoli, resulting in pneumonia.

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Cite this: Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults - Medscape - Dec 01, 2006.

Abstract and Introduction
Epidemiology and Transmission of Disease
Pathogenesis of Infection
Clinical Manifestations and Complications of Infection
Complications of Pertussis
Diagnosis of Pertussis
Management of Pertussis
Conclusions
References

Table 1. CDC Definitions of Clinical, Confirmed, and Probable Cases of Pertussis
A clinical case is defined as an acute cough illness lasting 14 days in a person with at least one pertussis-associated symptom (ie, paroxysmal cough, post-tussive vomiting without other apparent cause, or inspiratory whoop) or, in an outbreak setting, ≥ 14 days of cough with no other symptoms.
A confirmed case is defined as a cough illness of any duration in a person from whom B. pertussis is isolated, or a case that meets the clinical case definition and is confirmed by polymerase chain reaction (PCR) or by epidemiologic linkage to a culture- or PCR-confirmed case.
A probable case meets the clinical case definition but is neither laboratory confirmed nor epidemiologically linked to a laboratory-confirmed case.
Confirmed and probable cases of pertussis should be reported to the National Notifiable Disease Surveillance System (NNDSS) of the US Centers for Disease Control and Prevention.

Table 2. Stages of Pertussis Infection ^[24]
	Duration	Characteristic Signs and Symptoms
Incubation period	7 to 10 days (range, 4 to 21 days)	--
Catarrhal stage	7 to 14 days	Insidious onset of coryza, sneezing, and a mild, nonspecific cough that gradually becomes more severe
Catarrhal stage	7 to 14 days	In infants: excessive sneezing or 'throat clearing'
Paroxysmal stage	1 to 6 weeks (up to 10 weeks)	Bursts, or paroxysms, of numerous, rapid coughs followed by a long inspiratory effort often associated with a high-pitched whoop; post-tussive vomiting.
Paroxysmal stage	1 to 6 weeks (up to 10 weeks)	In infants: paroxysms of coughing, but may not have sufficient musculature to develop a whoop. In addition, they may experience gagging, gasping, or eye bulging, and occasionally bradycardia or cyanosis.
Convalescent stage	Weeks to months	Recovery gradual, with cough becoming less paroxysmal and then disappearing. Fever is generally minimal

Table 3. DTaP/Tdap Vaccination: Recommendations of the Advisory Committee on Immunization Practices ^[37,38,39]
Dose	Age	Minimum Interval
Routine Primary Immunization of Infants
1	2 months	-
2	4 months	4 weeks
3	6 months	4 weeks
4	15 to 18 months*	6 months
5	4 to 6 years
Booster dosing of adolescents:	11 to 12 years	-
Booster dosing of adolescents:	13 to 19 years	-
Dosing of Adults^§
All adults who expect to be in close contact with a vulnerable infant	19 to 64 years
Health care personnel	19 to 64 years

*May be given at 12 months.
If 4th dose given before age 4 years.
Catch-up vaccination recommended if Td not received at 11 to 12 years; vaccination with Tdap encouraged for those who received Td at 11 to 12 years with a 5-year interval between Td and Tdap.
^§A single dose of Tdap booster to replace the next scheduled dose of tetanus diphtheria vaccine.
^¶Infant who has not received 2 to 3 doses of DTaP.

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